The Social Security Disability Determination Process

Last updated 3 months ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.

Applying for Social Security Disability benefits can feel like navigating a maze. This guide breaks down each step of the process in plain language to help you understand what to expect, how decisions are made, and what you can do to strengthen your application.

What is Social Security Disability?

The Social Security Administration (SSA) manages two programs that provide benefits to people with disabilities:

• Social Security Disability Insurance (SSDI) – For workers who have paid into the Social Security system through payroll taxes and become disabled
• Supplemental Security Income (SSI) – For people with disabilities who have limited income and resources

Both programs use the same disability determination process, but they have different eligibility requirements for work credits and financial resources.

Who Qualifies as “Disabled”?

The SSA has a specific definition of disability. To qualify, you must:

1. Be unable to do substantial work because of your medical condition
2. Have a condition that has lasted or is expected to last at least 12 months or result in death
3. Be unable to adjust to other work due to your medical condition

The SSA uses a five-step process to determine if you meet this definition.

The Five-Step Disability Determination Process

Step 1: Are You Working?

First, the SSA checks if you’re currently working. If you earn more than a certain amount each month (called “substantial gainful activity” or SGA), you generally cannot be considered disabled.

For 2025, the SGA amount is $1,550 per month for non-blind individuals and $2,590 for blind individuals.

If you’re earning less than the SGA amount or not working at all, your application moves to Step 2.

Step 2: Is Your Condition “Severe”?

For the SSA to consider you disabled, your condition must significantly limit your ability to perform basic work activities like:

• Standing, walking, lifting, or carrying
• Sitting or pushing/pulling
• Basic mental functions needed for work

Your condition must limit you for at least 12 months. Minor or short-term conditions don’t qualify.

If your condition passes this “severity test,” your application moves to Step 3.

Step 3: Is Your Condition in the Listing of Impairments?

The SSA maintains a Listing of Impairments, often called the “Blue Book.” This lists medical conditions that are so severe they automatically qualify as disabling.

The listings are organized by body systems and include specific medical criteria that must be met. For example, if you have respiratory disorders, the listing specifies exactly what test results and symptoms qualify as disabling.

If your condition exactly matches or is medically equivalent to a listing, you’re approved for disability. If not, the evaluation continues to Step 4.

Step 4: Can You Do Your Past Work?

If your condition doesn’t meet a listing, the SSA assesses your residual functional capacity (RFC). This is a detailed evaluation of what you can still do despite your limitations.

Your RFC considers physical abilities (lifting, standing, walking), mental abilities (concentration, following instructions), and other factors like environmental restrictions.

Using your RFC, the SSA determines if you can still perform any job you’ve done in the past 15 years. If you can still do your past work, your claim is denied. If not, the process moves to Step 5.

Step 5: Can You Do Any Other Type of Work?

In this final step, the SSA considers whether you can adjust to other types of work based on:

• Your age
• Education
• Past work experience
• Transferable skills
• Your RFC (what you can still do)

The SSA doesn’t have to find an actual job for you or prove that a specific employer would hire you. They only need to show that jobs exist in significant numbers in the national economy that someone with your limitations could perform.

Older applicants (over 50) have an easier standard to meet under what’s called the Medical-Vocational Guidelines, often called the “Grid Rules.”

If the SSA determines you cannot adjust to other work, your claim is approved. If they find you can do other work, your claim is denied.

Who Makes the Decision?

The disability determination process involves several people:

1. SSA Field Office Staff – They handle the initial application and check non-medical eligibility requirements
2. Disability Determination Services (DDS) – State agencies that work for SSA and make the initial medical decision
   • Disability Examiners – Review your case and gather medical evidence
   • Medical Consultants – Doctors who review medical evidence and help assess limitations
3. Administrative Law Judges (ALJs) – If you appeal a denial, an ALJ conducts a hearing and makes a new decision

How Medical Evidence is Evaluated

Medical evidence is the cornerstone of any disability claim. The SSA collects information from:

• Your treating doctors
• Consultative examinations (if needed)
• Hospital records
• Laboratory results
• Medication history

The SSA follows specific rules for evaluating medical evidence, including:

• Treating Source Rule – Your regular doctor’s opinion gets special consideration
• Medical Source Statements – Forms that doctors complete about your functional limitations
• Consultative Examinations – If your medical evidence is incomplete, the SSA may send you to a doctor for an exam at their expense

The Application Timeline

Here’s what to expect after you apply:

1. Initial Application – Takes about 3-5 months for a decision
2. Reconsideration (first appeal) – Takes about 3-5 months
3. ALJ Hearing (second appeal) – Currently takes about 12-18 months in most states
4. Appeals Council (third appeal) – Takes about 18-24 months
5. Federal Court (final appeal) – Takes 1+ years

Common Reasons Claims Are Denied

Understanding why claims are denied can help you avoid common pitfalls:

1. Insufficient Medical Evidence – Not having detailed, consistent medical records is the top reason for denial
2. Failure to Follow Treatment – If you don’t follow prescribed treatment without good reason, the SSA may deny your claim
3. Inability to Contact You – Make sure the SSA always has your current contact information
4. Substantial Gainful Activity – Working above the SGA level during the application process
5. Drug or Alcohol Contribution – If substance abuse is a material factor in your disability, you may be denied

Special Considerations for Mental Health Conditions

Mental health claims face unique challenges. The SSA evaluates mental disorders under Listing 12.00 and considers:

• Your ability to understand, remember, and apply information
• Interact with others
• Concentrate and maintain pace
• Adapt or manage yourself

Medical evidence for mental health claims should include:

• Clinical notes from psychiatrists or therapists
• Response to medications
• Psychiatric hospitalizations
• Psychological testing results
• Statements about daily functioning

The Role of Compassionate Allowances and Quick Disability Determinations

The SSA has special programs to speed up decisions for the most serious conditions:

1. Compassionate Allowances (CAL) – A list of conditions so severe they qualify for immediate approval, like ALS or pancreatic cancer.
2. Quick Disability Determination (QDD) – Uses predictive computer modeling to identify claims with a high probability of approval.

These programs can result in approvals in as little as 10 days instead of months.

The Importance of Work History

Your work history affects your disability claim in several key ways:

1. SSDI Eligibility – You need enough work credits to qualify for SSDI
2. Past Relevant Work – The jobs you’ve done in the last 15 years are evaluated in Step 4
3. Transferable Skills – Skills from past jobs are considered when determining if you can do other work
4. Substantial Gainful Activity – Your earnings history is reviewed to check for SGA

Maintain a detailed work history including job titles, duties, physical requirements, and dates of employment.

How Attorneys and Representatives Help

Over 80% of claimants at the hearing level have representation. Representatives can:

• Help gather the right medical evidence
• Communicate with your doctors to get supportive opinions
• Prepare you for questions at the hearing
• Cross-examine vocational and medical experts
• Make legal arguments based on SSA rules and regulations

Representatives usually work on contingency, meaning they only get paid if you win. Their fee is limited to 25% of your past-due benefits or $7,200, whichever is less.

The Appeals Process

If your initial application is denied, don’t give up. Many claims are approved on appeal. The appeals process has several levels:

Reconsideration

A complete review of your claim by someone who did not take part in the first decision. New evidence can be submitted at this stage.

Administrative Law Judge (ALJ) Hearing

If reconsideration is denied, you can request a hearing before an ALJ. This is the most important stage of appeal, where you have the best chance of approval.

The hearing is informal but recorded. You’ll answer questions about your condition, limitations, and work history. Medical and vocational experts may testify.

Appeals Council

If the ALJ denies your claim, you can ask the Appeals Council to review the decision. They may deny your request, send it back to the ALJ, or rarely, approve your claim directly.

Federal Court

The final level of appeal is filing a lawsuit in federal district court. At this stage, you’ll need an attorney with experience in federal court litigation.

Continuing Disability Reviews

If approved for benefits, your case will be periodically reviewed to verify you’re still disabled:

• Medical improvement cases are reviewed every 3 years
• Cases where improvement is not expected are reviewed every 5-7 years
• Some cases have a “diary date” for earlier review

During a Continuing Disability Review (CDR), the SSA gathers updated medical evidence. You’ll stay on benefits unless they can show your condition has medically improved and you can now work.

Working While on Disability

The SSA has work incentives that let you test your ability to work while keeping benefits:

1. Trial Work Period (TWP) – You can work 9 months (not necessarily consecutive) within a 60-month period and keep full SSDI benefits regardless of how much you earn.
2. Extended Period of Eligibility (EPE) – After the TWP, you have 36 months where benefits are paid for months you earn below SGA and suspended for months above SGA.
3. Ticket to Work Program – Offers free employment support services and protections during CDRs.

Learn more about these programs at the Choose Work website.

Applying for Benefits

You can apply for disability benefits in three ways:

1. Online at SSA.gov
2. By phone at 1-800-772-1213
3. In person at your local Social Security office

Before applying, gather:

• Medical records and doctor contact information
• Medication list
• Work history for the past 15 years
• Most recent W-2 or tax return
• Social Security number and proof of age
• Bank account information for direct deposit

What Happens After Approval

If approved for disability benefits:

1. You’ll receive a Notice of Award explaining your benefits
2. There’s a 5-month waiting period from your disability onset date before SSDI payments begin
3. After receiving SSDI for 24 months, you automatically qualify for Medicare
4. SSI recipients typically qualify for Medicaid immediately

Your monthly benefit amount depends on your earnings history for SSDI or your current income and living situation for SSI.

How to Improve Your Chances of Approval

Follow these tips to strengthen your disability claim:

1. Get Regular Medical Treatment – Consistent medical records are crucial
2. Follow Doctor’s Orders – Comply with treatment recommendations
3. Keep a Symptom Journal – Document how your condition affects daily activities
4. Be Specific About Limitations – Clearly explain what you cannot do, not just what condition you have
5. Meet All Deadlines – Appeal within 60 days of any denial
6. Consider Representation – Statistics show represented claimants have higher approval rates

Resources for Applicants

These resources can provide additional help:

• SSDI & SSI Application Help – Official SSA application portal
• Disability Starter Kits – Checklists and worksheets to help you prepare
• Blue Book Listings – Medical criteria for automatic approval
• Find a Social Security Office – Locate your nearest SSA office
• Disability Benefits Help – Non-profit information and assistance

Special Situations and Expedited Processing

Some situations qualify for special handling:

1. Terminal Illness – Cases with a terminal diagnosis receive expedited processing
2. Military Service Members – Wounded warriors and veterans may qualify for expedited processing
3. Presumptive Disability – Some severe conditions can qualify for immediate SSI payments for up to 6 months while a final decision is made
4. Dire Need – If you’re facing homelessness or lack of medical care, you can request expedited processing

Contact the SSA directly if any of these situations apply to you.

Understanding the Disability Determination Process Makes a Difference

Navigating the Social Security Disability system is challenging, but understanding how decisions are made improves your chances. Take time to gather strong medical evidence, clearly document your limitations, and persist through the appeals process if needed. With preparation and patience, you can successfully navigate the disability determination process.

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.